Self-Medication among Undocumented Latin American Migrants in Geneva, Switzerland: A Good Solution for Improving Access to Healthcare?

1Community medicine and primary care department, University Hospitals of Geneva and University of Geneva, 2Community medicine and primary care department, University Hopitals of Geneva and University of Geneva, Geneva, Switzerland

Self-medication is a frequent response to common health problem worldwide, the risks and benefits of which are a concern for medical practitioners. Self-medication practices are influenced by personal, sociocultural and economic factors, as well as by drug sale policies and legal frameworks.
For people living in precarity, with poor access to health care, self-medication is often the only treatment option. We conducted a study among patients attending the UMSCO (Unité Mobile de Soins Communautaires), a primary care clinic for the uninsured people in Geneva. The purpose of our study was to describe self-medication practices among undocumented Latin American patients (the main patient population at the UMSCO), and in particular to explore the use of antibiotics and injectable medications (“lay injection”), as well as the importation of medicines from patients’ home countries.

Methods:

We conducted a qualitative study through semi-structured interviews with patients attending the UMSCO during a three-month period. All undocumented Latin American patients who reported practicing self-medication were eligible to participate. After obtaining signed consent to participate in the study, a trained nurse conducted semi-structured interviews with patients. All interviews were conducted in either Spanish or French and lasted approximately 35 minutes.

Results/Conclusions:

(partial analysis) We conducted 67 interviews with patients coming mainly from Bolivia, Brazil and Ecuador. The participants were mostly middle-aged women, who migrated for economic reasons to Geneva and were employed in domestic work. We found that antibiotic for systemic use was frequent, especially with amino-penicillins. Oral administration was more frequent than by injections. We did not find significant differences in antibiotic use among different nationalities. Respondents believed that antibiotics are “strong”, “ kill everything” and are “very effective”. Reference to “bacterial” infection was rare. We also found that medicines from patients’ home countries were frequently used. These were usually sent to patients by family members, and included analgesics (nonsteroidal anti-inflammatory drugs and paracetamol), antibiotics and vitamins. Injectable medicines were occasionally purchased, and administered by “lay experts” (individuals with minimal health care skills) in the Latin American community. Self-medication is frequent in our sample and involves regularly prescription-only medicines. The clinical implications of this contextualized study may be summarize as follow: there is a need to systematically : 1) investigate self-medication and financial resources into the clinical encounter; 2) address patient’s social and personal representation of medicines (especially antibiotics); 3) look for patient’s informal and popular sector of health care.
Our results suggest the need for implementation of community health programs aimed at informing the undocumented Latin American community about the risks and benefits of self-medication and the appropriate use of medicines.